Examining impacts of structural racism and discrimination on Hispanic treatment differences and oral health disparities; known internally as "Smiles of Hope - Proyecto Hispanico de Esperanza" (SoPHE)

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Project Summary/Abstract (30 lines of text): The Hispanic population is the largest (>18%) and fastest growing non-majority ethnic group in the United States (US), about half of whom are non-US born. Hispanic children are three times more likely to have dental caries experience than White children, impacting quality of life and school learning and readiness. Current knowledge around oral health in Hispanic populations examines individual factors such as culture and acculturation, but research regarding the effect of structural racism and discrimination (SRD) factors on oral health treatments and outcomes is lacking. Although Hispanic children have higher rates of caries, initial research shows a discrepancy between rates of preventive and dental treatments visits for White and Hispanic children. The objective of this proposal is to evaluate area-level differences in oral health treatments provided to Hispanic children compared to non-Hispanic White children as a measure of SRD on individual-level subsequent caries incidence and increment through both quantitative (secondary data analysis) and community-based qualitative methods (focus groups). Our research would be the first to assess the impact of SRD on oral health using to-be-validated ZIP code-level measures associated with racial/ethnic residential segregation. This project aims to examine differences in oral health treatments provided (e.g., prevention, restoration, restraint, sedation, extraction) to be used as an SRD measure, and impacts on oral health outcomes among Hispanic children compared to White Children using multistate longitudinal oral health datasets. Researchers will also assess ZIP code-level SRD variables (e.g., child opportunity index, racial/ethnic opportunity gap, citizenship status, and limited English proficiency percentage) as potential effect modifiers of the relationship between oral health treatments provided as an SRD measure and impacts on oral health outcomes (caries incidence) among Hispanic children. Focus groups will be conducted with Hispanic families (including immigrants, people with limited English proficiency, and non-citizens) to gain a deeper understanding of how multi-level SRD factors are experienced among adults for themselves and their children, especially relating to access to dental care, treatment options, and oral health outcomes; and which family, organizational, neighborhood, and community protective factors help people overcome SRD barriers to help optimize their oral health. This research has significant implications, as it will provide a deeper understanding of how SRD affects Hispanic oral health and identify potential protective factors that could inform intervention development to address issues related to inequities in oral care.